Thoracal flat back is a risk factor for lumbar disc degeneration after scoliosis surgery

Bernstein, Peter S.; Hentschel, Susanne; Platzek, Ivan; Hühne, Sebastian; Ettrich, U.; Hartmann, A.; Seifert, J.

doi:10.1016/j.spinee.2013.07.426

Cited by 40 publications

(18 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hypokyphosis in Lenke 1 AIS patients has been correlated to decreased HRQOL not only during adolescence but also in adulthood. Bernstein et al [ 5 ] also revealed that the failure of kyphosis restoration after scoliosis surgery predisposed to lumbar disc degeneration during the follow-up. Thus, a proper restoration of TK is essential for Lenke 1 AIS patients.…”

Section: Introductionmentioning

confidence: 99%

Could pelvic parameters determine optimal postoperative thoracic kyphosis in Lenke type 1 AIS patients?

Liu

Zhang

Bao

et al. 2018

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundA proper restoration of sagittal alignment is essential in AIS patients, but few studies provided a formula to predict an optimal surgical thoracic kyphosis (TK) gain in adolescent idiopathic scoliosis (AIS) patients. A formula was recently proposed (LL = (PI+TK)/2 + 10) to predict the optimal lumbar lordosis (LL) in adult spinal deformity patients, which has not been validated in adolescents. The aim of this study is to establish a formula with TK and pelvic parameters in normal adolescents and predict an optimal TK with this formula pre- and post-operatively in Lenke 1 AIS patients.MethodsA total of 60 asymptomatic adolescents were used to validate the proposed formula. The subject was considered to match with the formula, if the difference between the virtual TK and the theoretical TK was less than 10°. Then regression analysis was performed to establish a new formula to predict TK in adolescents. The predictive efficiency of the new formula was also validated in 40 Lenke 1 AIS patients.ResultsOf the 60 asymptomatic adolescents, only 26 (43.33%) asymptomatic adolescents matched with the adjusted formula: TK = 2 × (LL-10)-PI. The paired t test revealed a significantly different theoretical TK (tTK) compared to the virtual TK (41.23 ± 18.29° vs. 24.80 ± 8.75°, P < 0.001). Multiple linear regression showed that TK had a relationship with LL, SS and age (R2 = 0.331): TK = − 0.785 × LL-0.843 × SS + 0.858 × age + 3.754. There were 27 (67.50%), 32 (80.00%) and 35 (87.50%) Lenke 1 AIS patients matched this formula preoperatively, postoperatively and at the last follow-up.ConclusionOur results revealed that the predictive formula for sagittal alignment for adults was not applicable in adolescents. This study established a new predictive formula for TK based on asymptomatic adolescents. In Lenke 1 AIS patients, post-op TK in 87.5% of patients matched the predictive value, indicating that the new formula can be considered as a reference when making a surgery strategy.

show abstract

Section: Introductionmentioning

confidence: 99%

Could pelvic parameters determine optimal postoperative thoracic kyphosis in Lenke type 1 AIS patients?

Liu

Zhang

Bao

et al. 2018

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…In particular, cut-off points have been suggested to keep LIV tilt at 5 degrees 9) , L3 or L4 tilt at 16 degrees 10) and lumbar curve at 39.5 degrees 11) . Conversely, Bernstein et al have found that sagittal view thoracic flat back was a risk factor for lumbar DD and that coronal parameters and LIV selection were irrelevant 12) . In our study, we found that in patients with DD, the lumbar curve and SVA were large at the final observation and that both the coronal and sagittal were involved.…”

Section: Discussionmentioning

confidence: 98%

Spinal Alignments of Residual Lumbar Curve Affect Disc Degeneration after Spinal Fusion in Patients with Adolescent Idiopathic Scoliosis: Follow-up after 5 or More Years

Akazawa

Umehara

Iinuma

et al. 2020

Spine Surg Relat Res

View full text Add to dashboard Cite

Introduction: Despite preserving lumbar disc mobility, spinal sagittal, and/or coronal alignment might ultimately impede surgical success. The purpose of this study was to elucidate the effects of spinal alignment on lumbar disc degeneration after 5 or more years in adolescent idiopathic scoliosis (AIS) patients who underwent spinal fusion.Methods: Subjects were 49 AIS patients who underwent posterior spinal fusion without lumbar curve fusion. The inclusion criteria were the following: 1) Lenke type 1A, 1B, 2A or 2B, 2) age 10 to 19 years at the time of operation, and 3) minimum 5-year follow-up. The exclusion criteria were the following: 1) diagnosed as other than AIS, 2) history of lumbar disc herniation and spondylolysis, 3) subsequent surgery, and 4) history of surgery before AIS surgery. Nineteen patients agreed to participate in this research. X-rays, lumbar MRI, and questionnaires were evaluated. Disc degeneration in nonfused segments was defined as Pfirrmann grade 3 or higher. Patients with disc degenerations at the final observation (DD[+] group) were compared to those without disc degenerations (DD[−] group).Results: There were no significant differences in the preoperative or postoperative 1-week X-ray parameters between both groups. The lumbar curve was significantly larger in the DD[+] group compared with the DD[−] group at the final observation (DD[+]: 16.8 degrees, DD[−]: 10.4 degrees, p = 0.035). The sagittal vertical axis (SVA) was significantly larger in the DD[+] group compared with the DD[−] group at the final observation (DD[+]: −4.4 mm, DD[−]: −34.3 mm, p = 0.006). SRS-22 function, self-image, and satisfaction scores were lower in the DD [+] group compared with the DD[−] group at the final observation.Conclusions: The patients with DD had significantly larger lumbar curve and SVA with lower SRS-22 function, selfimage, and satisfaction scores at the final observation. Even though the non-fused segments were preserved, spinal alignments of non-fused lumbar curve affect the DDs.

show abstract

“…Aging of the spine is often associated with decrease in LL due to degenerative disk disease. Bernstein establishes thoracal flat back as a risk factor for lumbar degenerative disk disease after spinal fusion [22]. The restoration of a large LL adapted to PI constitutes a capital for the long-term future of operated AIS.…”

Section: Discussionmentioning

confidence: 99%

Surgical increase in thoracic kyphosis increases unfused lumbar lordosis in selective fusion for thoracic adolescent idiopathic scoliosis

et al. 2018

View full text Add to dashboard Cite

show abstract

Thoracal flat back is a risk factor for lumbar disc degeneration after scoliosis surgery

Cited by 40 publications

References 33 publications

Could pelvic parameters determine optimal postoperative thoracic kyphosis in Lenke type 1 AIS patients?

Could pelvic parameters determine optimal postoperative thoracic kyphosis in Lenke type 1 AIS patients?

Spinal Alignments of Residual Lumbar Curve Affect Disc Degeneration after Spinal Fusion in Patients with Adolescent Idiopathic Scoliosis: Follow-up after 5 or More Years

Surgical increase in thoracic kyphosis increases unfused lumbar lordosis in selective fusion for thoracic adolescent idiopathic scoliosis

Contact Info

Product

Resources

About